Impact case study database

Pathway to Impact

To gain widespread uptake of climate-based daylight modelling (CBDM) outside of academia required winning the ‘hearts and minds’ of practitioner and wider-stakeholder communities, including policy makers and advisors. Key to achieving this in the UK were the many CBDM-themed invited presentations given by Prof Mardaljevic at CIBSE Daylight Group meetings (he has been Chair since 2014); invited presentations at Society of Light and Light Masterclasses (six venues across the UK); and numerous invitations to CIBSE Regional Events. Additionally, Prof Mardaljevic presented at 18 international events (between 2012-2018) in Europe, the US and South America which focussed on daylighting, CBDM and daylight metrics. Together, these activities laid the groundwork for influencing the practitioner and policy-making community (in the UK and beyond) to recognise CBDM as a necessary and important advance and, consequently, leading to acceptance for the proposal which became the EU standard. As noted by Paul Rogers, [Head of Daylight / Agency for Architecture & Urbanism, Stockholm]:

“In addition to his many influential lectures and papers on the subject over this time, specific mention must be given to [Prof Mardaljevic’s] work in advancing the calculation methods of the European daylight standard”. [S1]

The wide-ranging impacts from the research that culminated in the European Standard are as follows.

Impact 1: EN 17037 and Impact on National Standards, Legislation and Rating Schemes

All 34 EU/CEN member countries have implemented the standard on a national level. In the UK, the standard was adopted by the UK in May 2019. [S3] Publication of the standard has achieved impact far beyond implementation at the national level. It has been incorporated into national legislation (Denmark) with a legal requirement to demonstrate adherence. The United States Green Building Council have approved a version of the influential LEED (Leadership in Energy and Environmental Design) rating system for high latitude countries (>55°N) called ‘Nordic LEED’ where the default (US) daylight credit has been replaced with the EN 17037 formulation:

“… after working together with Sweden Green Building Council, our American counterparts at USGBC have approved our proposal. Amongst other things, LEED projects using this path will be able to prove compliance by exclusively using the methods of the new European Daylight Standard (EN 17037:2018).” [S1]

Other rating schemes which have adopted the standard include the Danish Green Building Council [S3] and the Irish Green Building Council ‘Home Performance Index (Well Being)’.

Impact 2: Adopted by the International WELL Building Standard

The internationally used WELL Building Standard is the first to focus “solely on the health and wellness of building occupants” [S6]. Based in the US, the WELL Standard is applied worldwide – the International WELL Building Institute website (Dec 2020) claims: “5,118 projects with 741 MILLION SQ FT [~70M m²] in 66 countries”. Version 2 of the standard (Q4/2020) adopted the performance evaluation methodology and recommended daylight levels of EN 17037 as an option to demonstrate compliance in ‘Concept L06: Daylight Simulation’, thus requiring for compliance the higher daylight illumination levels necessary for health and well-being than any previous standard. The EU 17037 daylight performance standard is approved to demonstrate compliance with the WELL Standard for buildings anywhere in the world, including the US [S6]. Consequently, Mardaljevic’s research, underpinning the EN 17037 standard, has global reach.

Impact 3: Transformed the Basis of Design Evaluation for Architects and ‘Daylight Designers’

For architect/designers the research has transformed the basis for the evaluation of new buildings which is now founded on annual profiles of daylight illumination instead of the single overcast sky used in previous standards.

In the UK, the recent revision of the ‘CIBSE/SLL LG2 (2019): Lighting for Healthcare Premises’ evidences this transformation:

“BS [EN] 17037: Daylight of buildings (BSI, 2019) requires the use of climate-based daylight modelling (CBDM), which takes account of the quality and quantity of sunlight and daylight. The introduction of these new metrics is leading to daylight design becoming a fundamental part of the architectural design. As such, daylight designers need to be consulted on massing, orientation and façade optimisation at the earliest stages of design even before detailed analyses are carried out.” [S2]

Impact 4: Major Upgrade of Practitioner Tools to align with EN 17037

The most commonly used software tools for daylight modelling were significantly upgraded to be able to carry out CBDM in order to compute the metrics required for EN 17037. These include the following leading developers/vendors of building simulation tools:

- DIAL+ https://www.dialplus.ch (Swiss based) [S8]

- LightStanza http://lightstanza.com (US based) [S8]

- MBS software https://www.mbs-software.co.uk (UK based) [S8]

- Climate Studio (Diva4Rhino) https://www.solemma.com (US based) [S8]

Practitioner engagement during the public consultation phase of the standard was vital to ensure that stakeholders were prepared for and understood the new requirements for more advanced daylight modelling tools. In response to increasing awareness of the upcoming standard [S3] [S4], various professional and industry bodies across the CEN member countries have hosted/supported numerous training events where EN 17037 and the tools to predict the new metrics were the focus. In the period between September 2018 and May 2019, a list compiled by the CEN/TC 169/WG 11 Secretariat records eight events in various countries (including France, Germany, UK, Switzerland) with at least 1000 participants in total. [S3] Notable in the UK was the Daylight Group event 30^th January 2019, demand was such that two back-to-back sessions were ran on the same day to cope with the capacity (~150 in total). Following stakeholder presentations (including from the developers of DIAL+), the attendees (mostly practitioners) rejected overwhelmingly (by 15 to 1) the draft Annex proposed by the BRE (a ‘daylight brexit’ keeping the existing British Standard and daylight factors) and voted instead to adopt the EU standard with only minor modifications in a heavily revised Annex. [S4]

Impact 5: Shaped Legal Decisions in Civil Litigation (Sweden) UK High Court Right to Light Cases

Although not intentionally formulated to quantify loss of light for planning disputes, the daylight performance basis of EN 17037 (requiring CBDM) has been used in high-profile Rights to Light (RTL) cases. Outcomes from RTL disputes have considerable influence over design/planning decisions, e.g., an injunction will either prevent a development occurring, or result in a ‘cut back’ to the design. The cases where CBDM/EN 17037 were used achieved settlement prior to hearings scheduled for the High Court, and so the details are not public.

XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XX ]S7XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX XXX XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX [S7]. Reflecting on this outcome, a partner of law firm Pinsent Masons LLP stated that:

“Professor Mardaljevic's work in researching and developing alternative methods of measuring and assessing light loss such as Climate Based Daylight Modelling is ground breaking and enormously important to support the establishment of an alternative to the Waldram Method, which I am certain will assist the proper and fair resolution of rights of light disputes in the future.” [S5]

Further reach of this impact is evidenced by a Civil Litigation case in Sweden, in which EN 17037 was, according to Paul Rogers of BAU Architects,

“successfully used… to support the plaintiff’s argument of [daylight] sufficiency”. [S1]

In every year since 2014, Loughborough researchers have worked closely with Highways England and their technical advisors, AECOM, to produce over 110 safety risk models covering the entire Strategic Road Network (SRN) [ S1], [ S2]. The SRN is the UK Government’s largest asset (£128Bn), a network of over 4,300 miles, with more than four million journeys made per day and carrying 1/3 of all traffic and 2/3 of all freight , more than three times the rail network . The UK government’s Department for Transport (DfT) collates unvalidated, inaccurate collision data (known as STATS19) for the UK road network annually. This data was provided to Loughborough as the only source of information upon which strategic safety decisions are made about changes and improvements to the 4,300 miles SRN across England.

The accurate data and models produced by LU helped HE to understand road safety holistically by looking at how vehicles, people and the design of the road infrastructure interact. For the first time, HE had accurate and intelligent information which allowed them to confidently consider a variety of intervention options – ranging from traditional engineering changes on the infrastructure, through to behavioural change campaigns and technology improvements to vehicle maintenance. Our collaboration with HE enabled a pathway to the following impacts:

Impact 1 Improved the safety of the SRN with 99% accurate accident data and models, giving HE the confidence to implement a new data-driven intelligence-led Safe Systems model.

Loughborough research on Artificial Intelligence (AI)-based algorithms to the UK government’s Department for Transport collision data improved collision data to 99% accuracy [ R2], [ R5] and led to Highways England to adopt a new approach to road safety based on our research – a Safe System Model (SSM) [ S1]. This enabled HE to meet its target to reduce the number killed and seriously injured on the roads by 40% by 31 December 2020. Since winning a competitive HE tender (Regional Delivery Partnership Technical Adviser Framework) with AECOM in 2014, our research has been applied across all regions in England ensuring any investment and intervention by HE is made at genuine collision sites across the SRN [ S1], [ S2].

Since 2014, HE has employed 99% precise collision data across the Safe Systems model of road safety improvements. The data and the risk models underpinned the compilation of the first set of more accurate Road Casualties on the Strategic Road Network [ S3], Regional Road Safety Reports [ S4], National Incident and Casualty Reduction Plan for HE for the SRN [ S5]. Research findings compiled in these reports served as the primary input to the HE’s Safe System approach to road safety management [ S1]. Consequently, the investment decisions of £17Bn in interventions made on the SRN between 2014 – 2019 used LU data to determine the optimum intervention and subsequent evaluation of the success of the intervention. In 2016, LU identified that an upward trend in KSI (Killed and Seriously Injured) was emerging and HE had to implement further measures to achieve its strategic outcome set by UK Government of a 40% reduction in killed or seriously injured casualties by the end of 2020 [S3].

Stuart Lovatt, Head of Strategic Road Safety at Highways England stated that [ S1, S6]:

“The partnership between Loughborough University, AECOM and Highways England has been an essential piece of our strategic development for over 8 years….we have been able to develop some strategic policies and procedures by looking in more detail at the in-depth analysis of collisions and casualties on the Strategic Road Network.”

Impact 2: A new Road Safety Delivery Programme (RSDP) was implemented to improve traffic safety across England.

LU research [ R1], [ R6] enabled the nationwide mapping of collision risk to identify KSI hotspots, high-risk routes and road users at risk of death and injury (e.g. motorcycle riders) across England. In addition, LU’s data and risk models were employed to develop a KSI forecasting tool which identified safety performance of the SRN over time and any shortfall in meeting the 40% KSI. This allowed HE to identify which regions required additional Interventions, how these should be best implemented and at what cost to meet the identified shortfalls [ S3]. Consequently, HE implemented a new approach to road safety, which is at the core of its Road Safety Delivery Programmes (RSDP) [S1], [S7]. Based on the 99% accurate collision data and over 110-regional safety-risk models created by LU every year throughout the current REF period [ S4], HE along with AECOM developed an intervention toolkit termed as ‘Guide to Road Safety Route Treatments’ [ S8] to determine and deliver the optimum and most cost-effective engineering, educational marketing campaigns and enforcement interventions to maximise incident and casualty reduction at the regional level [ S1], [ S2]. This facilitated the allocation and re-location of public budgets to where they would be most effective. The accuracy of the data and safety risk models provided to HE by LU allowed evidence-based intervention selection and subsequent evaluation, to monitor and review the changes made.

This richer understanding of the causal factors of a collision hotspot allowed effective interventions to be selected, implemented, and evaluated over time by HE. For example, it was estimated that the South West (SW) region required an additional level of investment of between 150-275M (£3 million per KSI saved, 200 new road schemes) to deliver a programme of targeted interventions to meet the 2020 target set by Government [ S1], [S7]. The intervention toolkit is flexible and adaptable and currently consists of 220 engineering and non-engineering-based interventions.

Stuart Lovatt asserted that [ S6]:

“LU research has enabled us to look at what kind of infrastructure improvements, as well as all kind of campaigns and behavioural change initiatives we need to develop.”

Taking the South West region as an example, a 19% reduction in personal-injury road casualties (from 1,593 in 2016 to 1,289 in 2018) was achieved in 2018 compared with 2016 owing to the targeted road safety schemes implemented during 2016-2017 [S4]. The accurate modelling and analysis of collision data by LU underpinned the identification of challenging sites, realised an understanding of the causal factors leading to the collision hotspot, enabling evidence-based intervention selection. These actions and initiatives had a wider impact than just safety improvement. Reduced injury collisions meant reduced associated costs including human, reduction in resulting congestion, road closure and improved journey time resulting in less impact on the road asset [S7]. Subsequent evaluation of the intervention was conducted through the analysis of accurate collision data and models year on year by LU. Implemented interventions in the South West region resulted in 304 less collisions in 2018, equivalent to a saving of £42.7m from the prevention of road closure (see cost of closures to the economy, i.e., £140.6K per collision that resulted in two-lane being closed for two hours for moderate traffic, [ S7]). Similarly, there were 20% less collisions (i.e., 3,568 collisions) on the entire SRN between 2014 and 2018 despite an increase of 8% in total vehicle miles travelled [S3]. This equates to a saving of £501m from the prevention of road closure.

The accuracy of the data allowed causal factors to be identified for the first time. For example: In the South West of England on the M48, there were 27 incidents/deaths between 2006-2016. But following the implementation of the improved data, (2013-2016) it was shown that 21 out of the 27 incidents were deaths caused by suicide NOT traffic related. Hence, HE implemented a suicide prevention strategy rather than introducing any changes to the road network [ S7]. This differentiation would not have been possible without LU’s accurate data and reporting.

Impact 3: Provided evidence to support the HE business case to Government to invest all vehicle excise duty (worth £27.4Bn) into road improvements from 2020-2025 for the first time.

The implementation of accurate collision prediction models in HE’s Safe Systems Approach has allowed any improvement to the SRN to be quantitatively evaluated over time and absolutely records the change in number of KSIs from 2014-2019.

Through the continued improvement and application of LU research [R2], [R5], HE was enabled to immediately identify and quantify the effectiveness of an intervention. Collision risk was measured and represented by colour on the map of the road network – so transition from a black to an amber hotspot represents an 85% reduction in KSI rates over the period. Improved data and risk models developed by LU were directly fed into HE’s safety risk guidelines termed as ‘ GG 104 Requirements for Safety Risk Assessment’ to address potential risks of further collisions [ S9].

This evaluation of the road safety interventions made has been fundamental in illustrating the return on the investment made by Government through Road Investment Strategy 1 worth £17Bn, (RIS 1) e.g., for every £1 invested in the SRN brings a £2 benefit to the economy and UK PLC. The quantitative evaluation also confirmed that HE met the Government’s target of 40% reduction in personal injury road casualties between 2014-2019 on the SRN.

As a consequence of meeting this target, Treasury made the fundamental decision in 2019 to invest all vehicle excise duty collected in England (£27.4Bn) in future road improvements for the first time [S10]. The £27.4Bn RIS 2 (Road Investment Strategy 2) programme managed by HE will run from 2020-2025 and will rely on accurate collision data and models [R6] provided to them by LU. This illustrates the importance of this research in enabling HE to measure, record, improve and protect the SRN across England - the Governments largest asset.

Senior Road Safety Policy Advisor - Anne-Marie Penny of HE stated that [ S1]:

“Improved data accuracy developed by LU has enabled us to strengthen our evidence-based strategies to delivery targeted road safety interventions with greater confidence. It also allowed us to evaluate the effectiveness of the intervention.”

The decision to adopt the delivery plan for HE 2020-25 [S10] represents a £27.4Bn investment decision by the Government that depends upon LU data and evidence, enabling HE to spend the investment wisely and innovatively, and continue to improve the government’s biggest national asset.

Loughborough University will continue to work with AECOM, after winning a place on Highways England’s Regional Delivery Partnership Technical Adviser Framework for the delivery of RIS 2 2020-2025.

Since July 2014, because of the national concern about overheating [S1], the visibility of the Loughborough team’s research has been amplified to public and building professional audiences. Pathways to the impacts described below have comprised:

a) seven invited media interviews (e.g., BBC News, ITV News, BBC Radio 4); newspaper articles (e.g., Daily Telegraph, Financial Times); six widely circulated professional press reports (e.g., CIBSE Journal, front cover article, the Royal Institute of British Architects Journal); and the worldwide reporting of R7 in specialist and general media outlets [S2].

b) a debate organised by The Edge, a campaigning, multi-disciplinary, built environment think-tank. Lomas, the lead speaker, addressed influential stakeholders from policy, architecture, house building, health, etc. including Lynne Sullivan OBE, Chair of the Good Homes Alliance (GHA); Alan Penn, Chief Scientific Advisor to the Ministry for Housing Communities and Local Government (MHCLG); Angie Bone, Head of Extreme Events and Health Protection at Public Health England; and Julie Godefroy, Technical Manager, CIBSE. The ‘ Edge Debate was lively, powerful and influential’ and ‘ led directly to action’ [S3] by the GHA and CIBSE (see Impact 3).

c) presentations at industry conferences and exhibitions [S2]. Following his 2017 Eco-Build talk, delivered from the stand of the Building Research Establishment (BRE), Lomas was invited to provide input to the second National [climate change] Adaptation Programme and to the research steering group of the project exploring changes to the building regulations. A presentation at the 2017 CIBSE Symposium [S2] led to research [R6] to evaluate the reliability of dynamic simulation models (DSMs) for overheating prediction within new Building Regulations (see Impact 4).

The team’s research, and the above activities, initiated a chain of impacts. Each impact makes an important contribution towards reducing overheating in buildings and provides an essential link in the chain which led to new Building Regulations for dwellings in England and Wales.

1. Compelled Government to address overheating in buildings: The UK Government took action to curb summertime overheating in UK buildings as a direct result of LU research which revealed, for the first time, the severity and extent of overheating in English homes and hospitals. The research evidence was delivered to government via the reports of the Adaptation Sub-Committee of the Committee on Climate Change (ASC), the Zero-Carbon Hub (ZCH) and other organisations. The ASC was established following the Climate Change Act, to assess the risks arising from climate change. The Government is compelled by law to heed the advice and guidance of the ASC and report back on the actions taken.

The ASC first alerted the UK Government to the problem of overheating in its 2014 report which relied almost exclusively on the large-scale field trials undertaken by LU, there being no other empirical evidence, at scale, available at the time [S4]. Referring to output [R1], the ASC noted that ‘ *Few studies have tried to monitor temperatures in homes across the country. One study …. found that 21% of homes studied exceeded overheating thresholds….*’ [S4]. Based on the work in the DeDeRHECC project, the ASC also reported that ‘ *Overheating is also a potentially serious issue in hospitals, …’ [S4].

In 2017, LU research was used by the ASC to further reinforce its evidence base and reiterated its call for government action. The report cited nine journal articles authored by LU staff, including R1 and R2. Based on this evidence, the ASC classified ‘ risks to health, wellbeing and productivity from high temperatures’ in its highest climate change risk category and a priority area for government mitigation action [S4].

The LU research also spurred others into action, notably The Zero Carbon Hub (ZCH), which had operational responsibility for achieving the (then) government target of delivering zero carbon homes in England from 2016. The ZCH mission also encompassed the unintended consequences of high levels of insulation, which includes summertime overheating. The ZCH 2015 report, ‘ Overheating in Homes: The Big Picture’, relied on [R1] and [R2] to evidence the extent of overheating [S4]. Subsequently, the ZCH published over 18 reports and other documents about the problem of overheating and led them to ‘ make recommendations to government and industry decision-makers on the types of frameworks which could cost-effectively incentivise …. action to tackle overheating in homes.’ [S4].

In 2018, the House of Commons Environmental Audit Committee asked the Government to explain its actions in response to the ASC’s recommendations to protect homes and public buildings, improve the resilience to heat waves of health care provision, and to change the Building Regulations [S1]. In its response [S1], the Government said ‘… MHCLG will consult on a method for reducing overheating risk in new homes’. The Government’s decision was a foundational link in the chain to Regulatory change reported as Impact 4.

2. Shaped Government policy: The research team was funded by BEIS, through the BRE, to undertake an analysis of overheating within the 2017 Energy Follow-up Survey (EFUS) [S5]. This was ‘ the largest survey of temperatures in English homes’, [S6] with measurements being made in 750 homes during England’s hottest ever summer. The EFUS ‘ provides the UK government with its primary source of data about the English Housing stock’ and enables BEIS ‘ to track the incidence of overheating … as the climate changes’ [S6]. Analysis methods developed through research were applied to data generated in an England-wide survey of temperatures in homes.

The EFUS reports were shared across Whitehall, and Lomas and colleagues reported their findings on four occasions to more than 15 government officials including John Saltmarsh, Deputy Director Engineering and Research at BEIS; Hunter Danskin, MBE, then Head of Technical Analysis at BEIS; and Victoria Tink, Building Regulations Part L Policy Lead, Technical Policy Division, MHCLG. The insights will shape the Government’s future policies on energy efficiency and overheating.

The monitoring campaign had four policy impacts. Firstly, the analysis ‘ represented a break from the ‘time honoured’ approach and .... proved much more insightful’. In particular, ‘ it is now clear that householders’ self-reporting cannot be used as the principal measurement of overheating in housing stocks’, which has important implications for the conduct of future EFUSs [S6]. Secondly, the analysis was ‘ crucially important as it permits BEIS to advance policies to reduce greenhouse gas emissions through improved energy efficiency without necessarily increasing the risk of overheating’ [S6]. Thirdly, and more generally, the work has provided the platform for framing ‘ future policies to reduce the risk of overheating’ [S6]. Interestingly, and unexpectedly, the analysis approach has also enable BEIS ‘ to understand more about wintertime underheating’ and fuel poverty, identifying ‘ which dwellings, with which occupants, are most at risk of ill-health’ [S6].

3. New building industry guidelines and standards: To enable the design of homes that are free of overheating, LU research has contributed to the development of new guidelines and standards and train engineers to use them.

The GHA, a charity that ‘ promotes higher quality sustainable housing and standards amongst architects, designers and house providers’, drew on the early research of Porritt. In 2014 he sat on the GHA Working Group [S7] that led to the GHA report, ‘Preventing Overheating: Investigating and reporting on the scale of overheating in England’. In 2019, as a direct result of the Edge Debate (see above), the GHA developed new guidance and a toolkit to identify new homes at risk of overheating [S7], the only academic work referenced is [R1]. Lomas heralded this innovation in an invited article for Buildings and Cities, the article was accessed over 1000 times in the two months post-publishing [S7]. The guidelines and tool kit were downloaded 1200 times in the first nine months after publication [S7].

CIBSE Technical Memoranda (TMs) are the primary point of reference for engineers in the UK and overseas concerned with providing comfortable and healthy buildings. They are the de-facto design and modelling standards referred to in the Building Regulations. In 2016, Lomas was the only academic invited to join the peer-review panel that oversaw the development of two new CIBSE TMs concerned with overheating in dwellings: TM59, which prescribes how engineers should use DSMs to identify designs which are likely to overheat; and TM60 to provide guidance on reducing these risk [S7, S8]. In the first three years after publication, over 4,100 copies of TM59 were downloaded from the CIBSE website [S7].

In 2018, in association with Design Builder, who provide the user interface to the world’s most widely used DSM, EnergyPlus, McLeod and Hopfe ran a CPD workshop to train consultants in the assessment of overheating risk using TM59 [S7].

Since December 2018, ‘ the designers of all new homes and developments in London are required to demonstrate compliance with TM59’ [S8]; design refinements are required if proposed dwellings fail to comply [S7].

4. New Building Regulations in England and Wales: LU academics demonstrated the uncertainty in the overheating predictions of DSMs and contributed to the Technical Working Group that formulated new Building Regulations.

In 2015, the CCC’s Progress Report to Parliament called on the MHCLG to ‘ … introduce a new required standard or regulation on overheating for new homes.’ The call was repeated in 2018 by the Environmental Audit Committee (EAC) saying the government should ‘ create a regulation to stop buildings which are prone to overheating’, they suggested: ‘ make use of a dynamic thermo-modelling test, such as the Chartered Institution of Building Services Engineer’s TM59 and TM52 guidance, a regulatory requirement for new buildings’ [S1]. The CCC and EAC reports ‘ galvanised activity at the MHCLG’ [S9].

However, much work was needed before such profound changes could be implemented and LU research was crucial: the MHCLG ‘ used a copy of’ our research [R7] ‘ in the office while undertaking the research and later during policy development’, ‘to help explain to people across the Department and Government why action is needed’ [S9].

In 2017, Lomas was invited by DEFRA to join the research steering group for the project led by AECOM [S9, S10] to investigate trade-offs between the costs to the construction industry and the improvement in health and life expectancy that would result from regulatory change. Lomas provided ‘ invaluable expertise’ [S9]. The project referred to four LU outputs including [R1 & R2] and concluded that regulatory change was desirable.

DSMs offer one possible approach to assessing the likelihood of overheating in new dwellings; but the reliability of their predictions is unknown. Working with industry partners, and with the encouragement of CIBSE [S8], the LU research team quantified the reliability of the most widely used DSMs when using the approach outlined in TM59 [R6]. The work was widely reported [S2] and demonstrated that DSMs produced surprisingly wide variations in predictions. The work helped to ‘ understand if and how dynamic thermal modelling might play a role in regulating overheating risk’ [S8].

In July 2019, the Building Regulations Advisory Committee, which is sponsored by the MHCLG, recruited new members whose work included overheating risk assessment [S10]. The Technical Working Group on overheating was set up by Tink (MHCLG, Building Regulations Part L Policy lead), ‘ to transform the body of research findings into a strategy for reducing overheating risk’ [S9]. Tink is a graduate of the London-Loughborough Centre for Doctoral Training (supervisor Allinson, see also [R4]), McLeod was also a member of this Working Group.

The Welsh and English governments have committed to mitigating overheating in new homes. Proposed new Building Regulations were published by the Welsh Government and the English Government [S10], with both governments creating entirely new Parts to the Regulations that focus solely on overheating. Both a simplified method, which draws on the GHA guidance, and a method based on the TM59standard and the use of DSMs, are presented. These new Regulations apply to all new homes in England and Wales and affect the whole housebuilding industry.

In [S9], Tink comments that LU research has ‘ broadened our understanding of the issues around overheating in homes, and the way that these insights have shaped the work of the MHCLG’. The new Regulations ‘ …., will be, to my knowledge, the first time that requirements will be imposed on the design of new buildings, due to concerns for human health and well-being, as a direct result of climate change’.

Research by Dixon and Smith identified and addressed a global need to deliver affordable approaches for early warning of landslides to protect vulnerable communities and critical infrastructure. The research was the focus of TV programmes (e.g., Discovery Channel Daily Planet, 2014; BBC Inside Out, 2016); received multiple awards (e.g., The Engineer Technology and Innovation Awards 2011, Institution of Civil Engineers Merit Award 2015, Hawley Award 2015, 2019 Philip Leverhulme Prize in Engineering; a LU 2017 Enterprise Award – with 1100 public votes); generated public, industry, and stakeholder enquiries from 26 countries leading to invited prestigious lectures (e.g., British Geotechnical Association), and an article in a global technical practice journal ( Geotechnical Instrumentation News, December 2016). Novelty and world leadership was demonstrated through UK patent GB 2467419, granted May 2011 [ S1]. Via these impact pathways, Dixon and Smith established AE monitoring of landslides as a viable, lower cost, alternative to traditional methods. Since 2014, impacts have been achieved in three areas:

Impact 1: Improved public safety and infrastructure protection via affordable and increased landslide knowledge in UK, Italy and Canada was achieved by using our novel Slope ALARMS (SA) sensors to monitor stability of critical infrastructure (e.g., flood defences, roads, and properties), protecting people and delivering improved public service. SA sensors have been selected by infrastructure operators and used at sites with risk of landslides in the UK (five), Italy (two) and Canada (one). In all cases, data from the monitoring systems have been used by engineers and infrastructure owners to understand and manage risks and deliver public safety. Examples include:

a) Flood defence (UK) - The Environment Agency installed a SA system to monitor stability of a flood embankment on the Humber Estuary that uniquely is threatened by rapid erosion of a deep channel. The embankment protects 144 properties, businesses, and a cement plant. Monitoring was required to help protect the village while a new flood defence was being constructed. Warnings from the sensor were automatically sent to the Flood Incident Duty Officer and integrated into the South Ferriby Site Specific Procedures Manual [ S2].

“Monitoring … was a complete success. It was the only affordable continuous monitoring solution with real-time warning capability that we could find. The significant benefit achieved was having confidence and peace of mind that the embankment was stable and capable of protecting those living and working in South Ferriby. While also knowing that we would receive an early warning if the embankment started to fail so that mitigation measures could be put in place to minimise the risk to residents.” [ S2]

b) Roads and property (UK) - SA sensors were installed in two unstable slopes in

Monmouthshire that threaten local roads and a property, with warnings sent to the Council.

“A key benefit of using Slope ALARMS was that sub-surface information could be obtained by retro fitting waveguides … hence installation would be rapid and costs would be very low.” [ S3] “ *The most significant benefit of the monitoring is that I have been able to reassure the owners, at the site near Skenfrith, about the stability of the slope above their property ….*”, “ This gives the owners peace of mind.” [ S3]

c) Coastal cliffs (UK) - Two slopes on the Yorkshire coast, near Filey and in Scarborough, have been monitored using SA sensors to help protect property and people.

“The AE system provides the only continuous measurements of slope deformation behaviour available to us.” [ S4] “…improves the reliability of our understanding of the problem and design recommendations …the scale and resolution of monitoring provided by Slope ALARMS was not previously available at an affordable price.” [ S4].

d) Road tunnels (Italy) – Five SA sensors were installed in a rock slope in Northern Italy that threatens the safety of two road tunnels that critically provide access for the local community and the 130,000 annual visitors to the region who rely on the tunnels.

“… the tunnels are the only way of accessing the village to/from the lower part of the valley, where many facilities, such as hospitals and industries, are located.” [ S6]. “…based on our monitoring data, FVG Strade [tunnel operator] has decided to close the old road tunnel indefinitely due to the risk posed by the rock mass. This decision has been made according to … evidence of the monitoring data. The driving of my way of thinking has been the AE data.” [ S5]. “… our community of 1500 people has benefited from the work that you have done to ensure our safety” [ S6].

e) Road (Canada) – Working with Thurber Engineering and Queen’s University, Canada, a major road route into Peace River that is threatened by landslides has been monitored using Slope ALARMS to support decision making by Alberta Transportation.

Impact 2: Enhanced community resilience to landslides in Myanmar and Malaysia was achieved using our CSS early warning approach. Working with not-for-profit organisations, FHI 360 and CCERR committee for emergency response, we engaged with local communities to improve understanding and effective use of the CSS system. This delivered improved safety and understanding. In Hakha, the capital of Chin State, we established the first slope monitoring project in Myanmar to protect communities. We trained 20 Landslide Response Volunteer (LRV) youths, 60% female, recruited via a radio appeal to install, maintain and operate the CSS system. The LRV in turn acted as trainers for landslide awareness and CSS monitoring for 80+ people from the community [ S7].

“A critical benefit of the work in Hakha has been raising awareness in the community to help improve community resilience to future landslide events”; “ I do not think that this would have been achieved without the research, technology and approach provided by LU. A unique impact of this collaboration on landslide monitoring was being able to align engagement of the central government of Myanmar all the way through the state government and CCERR agency to the youth volunteers and ultimately the community”; “ In Myanmar, this project has been a catalyst for future landslide monitoring projects and has established the groundwork for government awareness and support” [ S7]; “ We estimate around 15000 – 20000 population in Hakha town benefits from the project.” [ S8]

A second community application of the CSS landslide monitoring system was delivered in Ampang District, Kuala Lumpur, Malaysia, working with community group SlopeWatch, Universiti Sains Malaysia, and the government slope agency. Installation, maintenance, and operation of the CSS system was delivered with the community. Two workshops attracting 40+ participants facilitated increased awareness and understanding of landslide risks, communicated the benefits of monitoring and provided a forum for community engagement with government agencies and politicians.

Impact 3: The world’s first commercial, acoustic emission slope monitoring system, to deliver superior slope monitoring solutions, has been developed via a licensing agreement between LU and RST Instruments Ltd., a global geotechnical instrumentation company [ S9, S10]. The Geotechnical Instrumentation News article generated discussion and resulted in LU entering into an agreement with RST, Canada and UK, in October 2017 for an exclusive world-wide licence to further develop, manufacture and distribute an AE slope monitoring system. Transfer of IP covered all technical information on Slope ALARMS [ R1 to R5] and Community Slope SAFE sensors [ R6], plus LU associated knowhow on installation and operation of the AE slope monitoring systems. RST are a top five international geotechnical instrumentation specialist. With a global network of 22 distributors, sales result in an annual group turnover of ≈£29 Million [ S10]. RST produce monitoring systems for applications in mining (e.g., tailings dams) and infrastructure (e.g., slopes) [ S9]. Supported by Dixon and Smith, RST developed the world’s first commercial AE sensors, Geo-Acoustic Aware (GAA), for slope monitoring. GAA was marketed globally in 2020 [ S9].

“The business case for investing in development of … GAA sensor… was made by discussing the concept of the technology with a number of our high profile clients… The pull through revenue of having this unique product was also taken into account, generating additional sensors and increasing products sales across the board.” [ S10]

“RST… have invested considerable time, energy, and finance to develop, test and market the GAA sensor system. …this investment is over £200k and includes the creation of employment, as well as … benefits both within and to our supply chain.” [ S10]

“The addition of the product to the RST portfolio has added a unique value proposition… By allowing lower cost reliable measurement of slope stability we can provide a much more comprehensive monitoring solution… for no increase in budget. As no one else has this offering, interest in GAA has opened doors and generated conversations with new clients that otherwise would not have taken place”. [ S10]

RST report that to November 2020, there has been significant interest in employing GAA from large global mining companies because GAA has been identified as filling a gap in current monitoring options (e.g., monitoring tailings dams). In addition, client discussions are on-going for monitoring rail slopes in Scandinavia and landslides in India, Myanmar, and Indonesia. GAA is being used to monitor slopes by a road authority in China. [ S10]

“GAA forms an important part of RST’s future strategy.” [ S10]

Research by Osmani underpinned measures that transformed industry understanding and practice of designing out waste, leading to the development of a new multi-part British Standard (BS 8895 series). We describe (1) pathways to new British Standards on designing for material efficiency; (2) development and publication of BS 8895 series; and (3) demonstrate the multifaceted impact and reach since 2014.

(1) Pathways to new British Standards for designing for material efficiency

In 2009, the British Standards Institution ‘Built Environment Design Advisory Committee’ had identified “ design waste in building projects as a potential area for standardization. At this time, it was felt that designers would benefit from clear and unified guidance to help them achieve their sustainable construction goals and see those much-desired cost savings and reduced environmental impacts” (Anthony Burd, Head of the Construction Sector, BSI). Osmani was identified as the expert in this area and directly invited by Clare Price (Market Development Manager, BSI) to convene a collaborative think tank with RIBA (Royal Institute of British Architects) and WRAP (Waste & Resources Action Programme) to explore industry need for new British Standards on designing out waste. This was followed by a series of exploratory workshops with stakeholder groups and an online questionnaire sent to designers as potential users of the Standards. The results indicated that 85% of respondents concurred that there is a need for standards in this area. A multi-part standard across all design stages was the most popular option among responding architects. Subsequently, the think tank was extended to form a steering group, chaired by Osmani, to develop new British Standards: BS 8895 (Code of Practice: Designing for Material Efficiency in Building Projects). In accordance with the questionnaire results, the panel members agreed to publish a four-part standard to be linked to the RIBA Plan of Work Stages (0-7) (Figure 1): Part 1, published on 31 July 2013, is associated with project briefing (Stages 0 & 1); Part 2, published in 2015, is linked to concept and developed design (Stages 2 & 3); Part 3, published in 2019, relates to technical design (Stage 4); and Part 4, which is currently in progress, is associated with construction, handover and close out, and in use phases (Stages 5, 6 & 7).

Figure 1: Development of BS 8895 series in line with RIBA Plan of Work Stages

BS 8895-1:2013, which is a pre-impact pathway, aimed to integrate the process of designing for material efficiency during the pre-design and briefing stages of building or refurbishment projects to determine the material efficiency strategic direction and objectives in the project brief, which will be converted into designing out waste recommendations and actions in BS 8895-2:2015 and BS 8895-3:2019.

(2) Development of BS 8895 series: BS 8895-2:2015 and BS 8895-3:2019

Building on BS 8895-1:2013, Osmani led the development of BS 8895-2:2015 ( S1) and BS 8895-3:2019 ( S2). Dr Anna Fricker, BSI Standards Development Manager, confirmed that “ Professor Mohamed Osmani has served as the Convenor of the B/209/-/4 panel: Designing for material efficiency in building projects” ( S3). She stated that the panel, under Osmani’s Chairing, was “ responsible for the publication of BS 8895-2:2015 Code of practice for concept and developed design and BS 8895-3:2019 Code of practice for technical design” ( S3). Osmani managed collaborative input from the panel members comprising client organisations, architects, engineers, contractors; and coordinated contributions from Arup, BRE, RIBA and WRAP that led to the publication of BS 8895 Part 2 in 2015 and Part 3 in 2019.

BS 8895 series set out the process to create a standardized and qualified approach for the integration of designing for material efficiency across the life cycle stages of buildings allowing clients, design teams, consultants, and contractors to integrate the principles of designing out waste in construction projects. Material efficiency encompasses the efficient use of materials, waste prevention and reduction, minimizing damage to the environment and minimizing depletion of natural resources.

BS 8895-2:2015 ( S1) aimed to progress material efficiency objectives of the initial project brief into a design strategy that encompasses a systematic identification of material efficiency opportunities and designing out waste actions during concept and developed design stages. Osmani’s research on designing out waste ( R2) and design waste mapping ( R3) are included as references in BS 8895-2 Bibliography ( S1).

BS 8895-3:2019 ( S2) gave recommendations for the implementation of actions and outcomes from the developed design investigations in BS 8895-2 on optimising material efficiency in production information, such as information models, detailed drawings and material specification and coordination of technical design work undertaken by architects, structural and building services engineers, consultants, and specialist sub-contractors. Osmani’s research on design waste mapping ( R3) is included as a reference in BS 8895-3 Bibliography ( S2).

(3) Demonstrating the impact reach and significance

The impact reach and significance are demonstrated through: (i) reference to BS 8895 as the principal resource to optimise material efficiency and designing out waste practice in two international sustainability certification schemes (BREEAM and New Zealand Homestar) and a UK quality and sustainability assessment scheme (Home Quality Mark); and (ii) increased industry adoption of material resource efficiency in building projects.

(i) Guiding sustainability certification schemes

Reference to BS 8895 as the lead resource to guide designers and contractors to enhance material efficiency and designing out waste strategies and optimise associated credits in BREEAM (Building Research Establishment Environmental Assessment Method) ( S4, S5). Dr Shamir Ghumra, BREEAM Director, noted that BREEAM "bases the materials efficiency assessment methodology on the BS 8895 principles, published and led by Prof Osmani as Convener of the British Standards panel”; and the “ original research led by Osmani, its translation into the British Standard and the subsequent reference as the key material efficiency resource in BREEAM demonstrates the importance of this work as a key methodology to reduce the 136 million tonnes per year of construction waste in the UK” ( S5).

BREEAM is a global leader in the drive for a sustainable built environment and has contributed to the strong focus on sustainability in building design, construction and use that now exists in the UK. Underpinned by sound science and an independent assessment and certification process, the scheme provides clients with a means of assessing the environmental performance and potential of their buildings, management policies, processes, and supply chains using a standard that is consistent, flexible, and adaptable to local market drivers and opportunities (S5).

BREEAM is a successful UK export, active in 89 countries worldwide and the scheme of choice for 80% of the buildings assessed in Europe (S5). BREEAM has been used to rate the environmental performance of many thousands of buildings, with 14,000 trained building professionals and the issue of over 594,000 certificates for BREEAM assessments ( S5). With over 2.3 million international projects registered for assessment and achieving certification, the international reach of the scheme is set to continue ( S5).

In addition to BREEAM, reference to BS 8895 as a prime resource to optimise material efficiency and designing out waste best practice in construction projects is noted in:

• The ‘ Methodology’ and ‘ Waste Minimisation Actions’ in Home Quality Mark (HQM), which is a UK quality and sustainability scheme for new homes, which uses a 5-star rating to provide impartial information from independent experts on housing design, construction, quality and sustainability (S6).

• ‘Construction Waste Management’ and ‘ Construction Waste Reduction’ in New Zealand Green Building Council ‘Homestar’ rating system, which is an independent rating tool that certifies efficiency and sustainability of New Zealand homes ( S7).

(ii) Accelerating industry implementation of material resource efficiency

The last few years saw a significant surge in the adoption of BS 8895 guidance to improve material resource efficiency in the construction industry. Swan Housing Association, which provides high-quality affordable homes in England, prescribed in their Environmental Sustainability Strategy (2016-2021) that “ *Swan will adhere to the BS 8895 standard (Designing for Material Efficiency in Building Projects part 1 & 2). This ensures we consider the efficient use of materials from inception*” ( S8). Similarly, a waste assessment report for the development of Southend Airport Business Park identified the following benefits from implementing BS 8895-2: “ helps achieve higher levels of resource efficiency”; provides “ a flexible approach in applying material efficiency”; “ looks at the efficient use of materials”; fulfil “ corporate social responsibility criteria”; and addresses interrelated issues and processes” ... to improve material efficiency in building projects” ( S9). Construction stakeholders reported the following BS 8895 benefits ( S10):

• Understanding and implementing material efficiency: “ I am actually in the process of trying to establish what materials efficiency means for our projects and how we're going to implement it and also to give guidance to our future suppliers about how they can implement it. So a series of standards on this topic is really important for us” (Andrea Charlson, Sustainable Materials Manager, HS2).

• Clarity of material efficiency tools and checklists: “ BS 8895 is useful because it gives designers clear tools and checklists in order to make sure that they are designing for material efficiency” (Matthew Teague, Senior Architect, Tata Steel).

• Cost savings: “ One of the key benefits with material resource efficiency is the business benefits and what we mean by that is the cost savings. The cost savings for producing less waste, using less materials, cost savings through the construction program in terms of looking at different techniques, which may address materials efficiency but also savings in terms of the program such as prefabrication and also looking at in terms of the whole life cycle of the building and there may be cost savings in terms of how buildings are maintained and refurbished “(Katherine Adams, Principal Consultant, BRE).

Since 2014, Loughborough University researchers have collaborated closely with DHSC policy makers, NHS Improvement, NHS estate managers, clinicians, nurses, architects, engineers, patients, residents, and providers. The LU team and our expertise have been embedded within NHS regional strategic consultation exercises and hospital design processes. We contributed to policy development through commissioned research and membership of the following strategic and influential groups: DHSC Estates and Facilities Productivity Think Tank; DHSC Dementia Friendly Environment Working Group; DHSC Estates and Facilities Division Advisory Group; and the BIM4Health Task Group [S1, S2]. These led to impact in three areas:

Impact 1: Transformed the NHS’s capital funding and estate management practices

Our research into the SAM of healthcare estates changed the way NHS England spends its annual £3.7bn capital and £9.5bn estate management budgets, and in so doing improved the safety, efficiency and efficacy of healthcare services.

With over 1,500 sites, the NHS’s £83bn estate is one of Europe’s largest. It must meet safety and statutory standards, deliver increasingly complex clinical activities, and support enhanced efficiency and productivity. This is challenged by a legacy of old, unfit for purpose buildings, many approaching the end of their useful life: 18% pre-date the NHS (<1948) and 43% are more than 30 years old.

Following twelve research projects, and frequent direct engagement with DHSC, NHS Trusts, healthcare planners and practitioners, LU was commissioned by NHS Improvement to develop a new SAM plan. This research involved a national survey in conjunction with NHS Improvement of the 217 NHS Trusts (which employ around 800,000 of the NHS's 1.2 million staff); international and cross-sector comparisons; interviews; validation workshop, and analysis of Trusts’ annual returns which reported increasing safety failures and shutdowns, with maintenance backlogs growing to £6.5bn, causing significant risk to patients and service continuity. This led to LU’s nine evidence-based recommendations which, following their implementation, produced a step-change in how NHS assets are funded and managed.

The DHSC adopted our recommendations within its Health Infrastructure Plan (HIP, ‘ the biggest hospital building programme in a generation’) including the development of a new, strategic approach to improving healthcare infrastructure. Consequently, NHS capital funding allocations changed from a one-year to a five-year rolling allocation within a 10-year plan, with an effective replenishment, replacement, and disposal strategy for the NHS estate. Furthermore, the capital funding is now linked to short, medium, and long-term incentives and actions which has changed the way that the life cycles of NHS infrastructure and assets are governed, planned, financed, procured, designed, built, managed, and decommissioned [S1, S2].

Our ranking of maintenance backlogs within 223 NHS Trusts provided evidence to NHS Improvement in their discussions with Treasury as to where this funding should target and resulted in substantial new, long-term, investment in the future of the NHS estate, beginning with “ £600 million to reduce backlog maintenance and improve the NHS Estate; and 40 hospitals to be built by 2030 as part of a package worth £3.7 billion” [S1].

“The research evidence and recommendations informed and strengthened the NHS Innovation’s business case development for NHS Estate Funding and discussions with Treasury …. Without this evidence it is unlikely that the recently announced funding would have been secured.” [S1]

The NHS now plans and manages its estate in accordance with LU’s recommendations for a long-term approach and improved data quality, with a backlog data collection processes that is now embedded within the NHS Model Hospital and NHS Premises Assurance Model (PAM), with sustainability and estate digitalisation being central to the HIP [S1, S2].

Impact 2: Improved the quality of life and care for people living with dementia

LU research on how the built environment informed the selection, design, and operation of the DHSC England’s National Dementia £50 million Capital Investment Programme’s 115 England-wide pilot projects, the delivery and impact of which LU were employed to monitor and assess. This was achieved through our extensive knowledge exchange process and strong pathways created with project stakeholders (e.g., design teams and end-users), including a website, workshops, webinars, presentations from experts and 25 detailed case studies, report templates, and impact assessment methodology [S3].

Incorporation of our research findings within the design process by pilot projects delivered innovative dementia-friendly care environments, including the use of supportive technologies and dementia-friendly design details, which provided cost-effective benefits to ≈ 100,000 patients, staff and carers [ S3]. Self-evaluation of the changes by the project teams and analysis by LU researchers determined that in acute, social and community settings, sustained improvements in the three areas described below have been achieved over the past four years, and will remain for the foreseeable future [ S4]:

• People living with dementia benefited from reduced stigmatisation and institutionalisation, increased privacy and dignity, improved quality of life of (e.g., sleeping patterns, eating habits, daily activities, medication, interaction with relatives and staff) and reduced slips, trips, falls and challenging behaviour [S4, S5, S6, S7].

• Staff experienced calmer and safer environments and improved their understanding of the impact of the environment especially when managing complex needs [S4, S5, S6, S7].

• Care providers benefited from reduced costs associated with decreased staff sickness rates and turnover, and reduced interventions, e.g., medication [S4, S5, S6, S7].

There was significant roll-out of our research and pilot project experience into projects outside the DHSC Dementia Capital Programme, including in University Hospital Leicester (UHL) and Cambridge University Hospital (CUH) as testified by Rachel Northfield - Estates and Facilities, Head of Quality and Safety Governance, CUH:

“Principles from the project have been translated into other schemes wherever possible. It acknowledged that environments for those with dementia also support those with other disabilities or other needs” [S10].

The research has, according to the NHS, enabled them to “ achieve significant improvements in the quality of life of those living with dementia” [S1].

Impact 3: Produced new national guidance for designing dementia-friendly built environments

LU’s multiple award winning [S8] research and real time evaluation [S3] of how the built environment can provide dementia-friendly conditions in the UK’s hospitals and 32,000+ care homes has fundamentally changed the way the NHS specifies its new and upgraded facilities and how design consultants deliver them.

Our analysis of the DHSC England’s National Dementia Capital Investment Programme and its 115 pilot projects (costing £50 million) which led to improved QoL and care directly led to and shaped the development of Health Building Note HBN08-02, Dementia-friendly Health and Social Care Environments. [S9] This is the first HBN covering both health and social care and provides national guidance enabling architects, designers, and care providers to ensure all new or refurbished facilities are dementia friendly. The LU team are named as the only authors of the HBN. The Chief Executive of Care England, Prof Martin Green OBE said, in the Foreword:

“I am extremely delighted with this new guidance document, which has been put together by some of the leading figures in the health and social case sector… This expertise is now available to all those who are running or developing dementia services … [as] the foundation for all development and refurbishment decisions” [S9].

This guidance has been adopted in England, Scotland, and Wales. It is mandatory for the design of all new and refurbished NHS buildings, including HIP. It has also been embedded within national annual governance, evaluation, and assurance processes (e.g., NHS PAM and Patient-Led Assessments of the Care Environment: ‘PLACE’). This motivated care providers to improve their environments in ways which benefits the 850,000 (projected to increase to 1.6 million by 2040) people living with dementia in the UK [S1, S9]. There were clear and measurable improvements in the assessment scores of how the environment supported the provision of clinical care, assessing privacy and dignity, food, cleanliness, general building maintenance and the extent to which the environment supported the care of those with dementia [S9]. This quantifies and showcases the positive change made through the application of our research, now translated into published national design guidance, HBN08-02.

Finally, Price and Pantzartzis worked closely with the design team for the recently built new Emergency Floor, University Hospitals of Leicester (UHL). Dr Pillai, Head of Service, Emergency Department, used HBN08-02 as the basis for ensuring a frailty and dementia friendly design was achieved:

“UHL staff used the guidance contained within HBN 08-02 which led to better insight into design principles (floor, colour scheme, internal layout, visual impact etc) … Staff are unanimous in how it has improved the working condition for them and allowed them to provide better care to the patients”.

The outcome, and calmer environment, has improved patient care and experience. It has benefitted working environments leading to better staff morale, recruitment, and retention [S10].